clinical laboratory technology

(CLT 105 & CLT 106)
Elgin Community College
1700 Spartan Drive
Elgin, Illinois 60123
(847) 214-7322
Credits from these courses may be applied to the Clinical Laboratory Technology program,
therefore CLT policies will be followed. These requirements should be considered a supplement
to the ECC college catalog.
Organizational Chart ............................................................................................................2
Health Professions Mission/Vision Statements……………………………………………2
Course Descriptions………………………………………………………………………..3
Course Objectives ................................................................................................................3
Essential Requirements ........................................................................................................4
Health / Background Check Requirement ...........................................................................5
Safety Policy ........................................................................................................................6
Bloodborne Pathogen Exposure Policy................................................................................7
Academic Integrity ...............................................................................................................7
Professionalism Statement .................................................................................................12
Copy Services ....................................................................................................................12
Dismissal Policy………………………………………………………………………….13
Graduation Requirements ..................................................................................................14
Social Media Policy………………………………………………………………………14
Student Handbook Agreement……………………………………………………………16
Confidentiality Statement…………………………………………………………………17
Dr. Wendy Miller
Health Professions
Debbie Wollenberg
CLT/HST Program Director
Part-Time Faculty
Ann Bongen, Bhagwat Thakkar,
Melissa Volny, Kathy Wagner
Education Coordinators / Clinical
Lab staff at affiliated hospitals and clinics
The CLT Program is accredited by the
National Accrediting Agency for Clinical Laboratory Sciences (NAACLS),
5600 N. River Rd. Suite 720, Rosemont, IL. 60118
(773) 714-8880
Health Professions Mission Statement
The mission of Health Professions is to provide quality education that supports the development
of health and wellness practitioners.
Health Professions Vision Statement
The Health Professions Division will be recognized as a leader in providing quality education using
innovative teaching strategies. Our students will develop confidence in their discipline through
training in simulated and clinical settings. We will utilize interdisciplinary activities to instill a sense
of professionalism in our graduates and nurture an appreciation for lifelong learning.
Clinical Lab Assistant Student Handbook – 2013
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CLT 105 - Clinical Lab Assistant Skills I (2 cr)
Prerequisite: Acceptance into Clinical Laboratory Assistant program or program director
Description: The Clinical Laboratory Assistant is an important member of the clinical
laboratory team. CLAs are responsible for specimen collection and processing, reagent
preparation, instrument maintenance, and performance of basic laboratory tests. Units on medical
terminology, laboratory safety, infection control, use of diagnostic equipment, quality control,
customer service skills, and laboratory information systems will be covered.
CLT 106 - Clinical Lab Assistant Skills II (3 cr)
Prerequisite: Grade of C or better in CLT 105 or program director consent.
Description: This course builds on the skills learned in CLT 105. Students will perform basic
laboratory procedures in urinalysis, hematology, chemistry, microbiology, and immunology.
Students who successfully complete CLT 105 and CLT 106 will be granted credit for CLT 100 in
the Clinical Laboratory Technician program.
Upon completion of CLT 105-Clinical Lab Assistant Skills I, students should be competent in
each of the following objectives:
Describe the role of the clinical lab within the healthcare environment.
Describe departments within a clinical lab and the tests performed in each.
Describe the role of the clinical lab assistant within the clinical lab environment.
Perform specimen handling and reagent preparation according to procedure.
Operate and maintain basic laboratory equipment.
Evaluate quality control.
Perform mathematical calculations and conversions.
Follow infection control and safety policies.
Communicate effectively using appropriate medical terminology.
Upon completion of CLT 106-Clinical Lab Assistant Skills II, students should be competent in
each of the following objectives:
Perform point of care testing procedures in urinalysis, hematology, chemistry,
microbiology, and immunology.
Validate and report test results.
Follow infection control and safety policies.
Communicate effectively using appropriate medical terminology.
Demonstrate professionalism in work ethic.
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The CLT program has established minimum essential requirements (separate from academic
standards for admission) which every student must meet, with or without reasonable
accommodations, in order to participate fully in all aspects of training. These essential
requirements are divided into observational, movement, communication/cognitive, and
behavioral categories.
Essential Observational Requirements
The student must have the ability to observe and acquire information from printed and projected materials.
The student must be able to differentiate the color of structures both macroscopically and microscopically.
The student must be able to discern veins through tactile senses.
Essential Movement Requirements
The student must be able to travel to and from clinical sites for practical experiences.
The student must be able to move freely and safely about a laboratory.
The student must be able to reach laboratory benchtops and shelves.
The student must be able to tolerate lengthy periods of physical activity including sitting, standing, and moving
quickly at times.
The student must have sufficient fine motor control to collect and process potentially infectious specimens, to
safely handle laboratory chemicals, and to manipulate laboratory equipment requiring repetitive motion.
Essential Communication/Cognitive Requirements
The student must be able to effectively read, write, and speak in English, so as to communicate with
instructors, students, patients, and other members of the health care team.
The student must be able to follow oral and written instructions in order to perform tasks independently.
The student must be able to comprehend, memorize, analyze, and synthesize scientific information at a
level appropriate for Clinical Lab Technicians.
Essential Behavioral Requirements
The student must be able to prioritize and complete projects within realistic time constraints.
The student must be able to exercise judgment and decision-making skills during periods of stress.
The student must remain flexible and adaptable to change.
The student must recognize potentially hazardous situations and proceed safely.
The student must seek help when needed.
The student must be able to accept constructive criticism and work to improve performance.
The student must be able to work collaboratively with fellow students and instructors.
Graduates are expected to be qualified to enter the field of Clinical Laboratory
Technology. It is therefore the responsibility of the student with disabilities to request those
accommodations that he/she feels are reasonable and are needed to execute the essential
requirements as described. Students with disabilities must contact the Learning Skills Center to
arrange for support services. If a student does not inform the college of a disability, ECC is not
required to make any exceptions to any standard procedure.
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The Illinois Department of Public Health (IDPH) and The Joint Commission TJC has established
regulations that require Elgin Community College to mandate criminal background checks and
drug testing of all students in the Health Professions Division who will be participating in
clinical experiences. These regulations are based on the Illinois Healthcare Worker Background
Check Code. The College will comply fully with the IDPH and TJC regulations and requirements
governing criminal background checks and drug tests. The results of all individual criminal
background checks and drug tests will be kept in a secure location with controlled access. All
individual test results will be considered confidential.
Criminal background checks and drug testing must be completed by all students, after acceptance
into and no more than 30 days before the beginning of classes, in the Health Professions Division
where clinical training is required. Students with a history of a felony or disqualifying offense
without a waiver from IDPH and/or a positive drug test for illegal substances will be denied
admission and/or dismissed from the Health Professions Division. Students with a positive drug
test will be referred to the Student Assistance Program at ECC.
In addition, students:
• Will be responsible for all costs associated with criminal background checks and drug tests
(including repeat tests);
• Will be responsible for completing criminal background checks and drug tests from a source
recommended by the Health Professions Division;
• Who refuse to be tested will be considered positive for criminal background check and/or
drug test and will be denied admission to the Health Professions Division;
• With a positive drug test may not reapply to a Health Professions program for a period of one
year, and must supply a letter from a professional source documenting successful
• With two positive drug tests will be permanently dismissed from the Health Professions
• Whose drug test results are reported as dilute, must repeat the drug test within 24 hours of
notification or it will be considered a positive result;
• Must have a drug test repeated annually while in the Health Professions Division, and may be
required to submit to a random drug test if there is cause;
• Who leave the Health Professions Division for one or more semesters will be required to
repeat the drug test upon re-admission;
• Who allegedly tamper with a drug test sample or falsify information pertaining to a drug test
must repeat the drug test (collection will be witnessed) within 24 hours of notification.
Students who refuse to repeat the drug test within the 24 hour time period will be denied
admission to the Health Professions Division.
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Students must demonstrate competency in safety protocol during CLT 105. The following safety
precautions must be followed while in the student laboratory (A-218):
No eating or drinking is allowed while performing lab procedures.
Fluid resistant lab coats must be worn while performing lab procedures.
Disposable gloves must be worn when handling biological specimens.
Lab coats/gloves are not to be worn outside of the student laboratory.
Eyes must be protected with safety glasses or face shields when splashing is anticipated.
All chemical spills must be cleaned up immediately using the spill-kit.
All body fluid spills must be decontaminated immediately using a 10% bleach solution.
Any accidents (broken glassware, body fluid splashes, puncture wounds, etc) must be
reported to the instructor immediately and follow-up action initiated as directed (see ECC
Bloodborne Pathogen Exposure Policy).
Elgin Community College (ECC) students must adhere to the Student Code of Conduct
Discipline Procedure as stated in the college catalog. In addition, during on-campus laboratories
and clinical experiences, the Health Professions Department requires health profession students
to practice safe techniques, remain drug and alcohol free, maintain clear criminal background
checks, and demonstrate professional behavior at all times. These additional requirements are
necessary because health professions programs require students to perform procedures on fellow
students and patients in the laboratory and clinical setting.
Program Directors, faculty and Laboratory Coordinators/Directors may immediately remove a
student from a clinical experience on or off campus and recommend to the Associate Dean of
Health Professions a failing grade for a student in the clinical or laboratory setting for unsafe
behavior or technique, drug or alcohol use, background check violation, or the demonstration of
unprofessional behavior(such as but not limited to: physical or verbal threats, inappropriate
comments, physical abuse, offensive touching or use of force on a person without the person’s
consent, verbal abuse, intimidation, harassment, coercion and/or other conduct which threatens
or endangers the health or safety of any person). The Associate Dean of Health Professions with
consultation from the Dean of the Math, Engineering, Science, and Health Professions and the
Dean of Student Services will either uphold the recommendation or reinstate the student. The
recommendation for removal may result in permanent dismissal from the Health Professions
A student may choose to appeal a failing grade through the Grade Appeal Process as stated in the
college catalog. A student may choose to appeal a permanent dismissal from the Health
Professions Department through the Disciplinary Procedures as stated in the college catalog.
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In the event that a student is exposed to blood or body fluids while participating in student labs
on campus or training at affiliated clinical sites, the policy outlined below will be followed.
1. Immediately report exposure to instructor.
2. Thoroughly clean area with copious amounts of water and antibacterial soap. In case of
splashes to the eyes, flush with water for 10-15 minutes using an eyewash.
3. Report to the nearest emergency room/occupational health department for first aid and
baseline testing. Note: The student is responsible for any and all treatment expenses,
baseline testing, and damage or loss associated with such injury that is not covered
under the college’s accident policy.
4. Complete a Post Exposure Incident Report (available in the Health Professions office)
within 24 hours of the incident.
All students are required to read and sign the Health Professions Consent and Release form
before participating in any lab activities.
I. Statement on Academic Integrity
Elgin Community College strives to foster an environment of respect for and achievement of the
highest levels of academic integrity for all members of its academic community. Academic
integrity and honesty are essential hallmarks of the institution’s contributions to the greater
society and cannot be abridged without considerable harm to those who must rely upon the
intellectual pursuits of the institution.
The college community has responsibilities to all those within its sphere of influence, both within
the academic community itself and to the greater society which supports its work. [In Health
Professions this is interpreted to include all clinical sites that provide educational experiences.]
Institutional integrity can only be achieved through honesty, conscientiousness, and credibility of
the members of the ECC community itself. [In Health Professions this includes the professional
code of ethics for each discipline.] To that end, all members of the ECC community are expected
to comply with the college’s shared values, which emphasize excellence, freedom of inquiry,
equity, ethical practices, accountability, respect for diversity, and community engagement; and
with its codes of conduct, which expressly forbid cheating and plagiarism in all their possible
II. Acts of Academic Dishonesty include, but are not limited to the following:
A. Cheating
At its most basic level, cheating is the unauthorized use of outside assistance.
Cheating includes use of notes, study aids, or other devices that are expressly
forbidden by the instructor for the completion of an assignment or an
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examination. In addition, cheating occurs when a student looks at and/or copies
another student’s work.
B. Plagiarism
Plagiarism is the presentation of another person’s written words or ideas as one’s
own. Students are guilty of plagiarism if they submit as their own work:
part or all of a written assignment copied from another person’s
manuscript, notes, or computer code
part or all of an assignment copied or paraphrased from a source, such as a
book, magazine, pamphlet or electronic document, without giving proper
a paper purchased from any vendor
reusing or modifying a previously submitted paper for a present
assignment without
obtaining prior permission from the instructors involved
the sequence of ideas, arrangement of material, pattern of thought of
someone else, even though it is expressed in the student’s own words;
plagiarism occurs when such a sequence of ideas is transferred from a source
to a paper without the processes of digestion, integration and reorganization in
the writer’s mind, and without acknowledgement in the paper.
Students are guilty of being accomplices to plagiarism if they:
allow their paper (in outline or finished form), computer code, art, or other
independent work to be copied and submitted as the work of another
prepare a written assignment for another student and allow it to be
submitted as that student’s own work
keep or contribute to a file of papers with the clear intent that those papers
will be copied or submitted as work of anyone other than the author; students
who know their work is being copied are presumed to consent to its being
C. Fabrication
Fabrication is the invention or counterfeiting of data and/or research. [In Health
Professions this includes patient data.]
D. Complicity
Complicity occurs when a student provides assistance in any act that violates the
integrity policy. Complicity includes allowing other students to copy one’s own
work, assisting in cheating, sharing test questions/answers, selling a paper to a
paper mill/paper vendor, and any other act that would assist another student in
engaging in academic dishonesty. [In Health Professions talking during an
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exam/quiz is considered sharing information, and failure to report knowledge of
other students cheating is also considered an act of complicity.]
E. Multiple Submission
Multiple submission occurs when a student submits the same (or largely
unaltered) work in multiple courses without instructor approval.
Multiple submission does not include coursework in learning community or
linked courses (in which instructors develop assignments together), nor shall it
cover those situations in which a student has received approval to expand or
develop previous work.
F. Misconduct in Research
Misconduct in research occurs when a student violates professional guidelines or
standards in research, to include college standards and codes of conduct.
III. Resolution—Instructor
When an instructor identifies an act of academic dishonesty, the instructor shall inform the
student of the act by filling out the Notification of Violation of Academic Integrity Policy form.
The instructor shall determine the appropriate sanctions for the particular offense. Sanctions may
include a general warning, rewriting the paper/redoing the assignment, failing the assignment,
failing the course, and/or participating in the non-credit Writing with Integrity course. [In Health
Professions this may include dismissal from the program depending on the severity of the
offense. Refer to the Student Code of Conduct which lists behavior for which a student may be
subject to disciplinary sanctions by the College.] The student must also be informed of his or her
right to appeal the instructor’s determination to the appropriate Academic Dean.
If the student acknowledges his or her actions and accepts the penalty, the matter shall be at an
end. Documentation (the notification form) of the incident shall be forwarded to the Dean of
Students for recording.
If the student chooses to appeal the instructor’s determination, the student shall follow the
procedures outlined in the Student Appeal Process (Part IV). A student must appeal within ten
days of receiving the instructor’s determination.
Note: A second violation recorded with the Dean of Students shall result in administrative
sanctions as outlined in the Administrative Procedure 4.402 (Student Code of Conduct), which
may include suspension and/or expulsion.
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IV. Student Appeal Process
A student charged with an act of academic dishonesty may appeal the instructor’s determination.
Within ten days of receiving the instructor’s determination, a student must submit a letter
outlining his or her appeal to the appropriate Academic Dean. The Dean shall review the
student’s documentation and make a determination within ten days of receiving the student’s
request for review.
The Dean may find there is sufficient evidence to merit further review, and the matter shall be
forwarded to the Vice President of Teaching, Learning and Student Development. If the Dean
determines there is not sufficient evidence to merit further review, the appeal shall be denied. If
the appeal is denied, the student may appeal in writing within ten days to the Vice President.
The Vice President of Teaching, Learning and Student Development shall review any
recommendation from the Academic Dean and/or the student letter of appeal within ten days.
The Vice President may find there is not sufficient evidence for review, and the appeal shall be
denied. If the appeal is denied, the matter shall be at an end.
If the Vice President agrees that there is sufficient cause for further review, the Vice President
shall convene a Faculty Review Committee for a hearing within ten days. The Vice President
will notify ECCFA of the need to appoint and convene a Faculty Review Committee. The
committee will be comprised of three faculty members, one of whom must represent the
department or division in which the offense occurred. ECCFA will consult with the Vice
President and will select these members within ten days of receipt of the request. After ten days,
if ECCFA is unable to fulfill the request, the Vice President shall appoint, in consultation with
ECCFA, the faculty representatives for the committee. The faculty members will elect the chair
of the committee. The student shall be notified of the members of the committee. Should the
student have a good faith objection to a committee member, the student should request an
alternate appointment from the Vice President. The Vice President shall determine if a
replacement is warranted.
The committee will hold formal hearing(s) at which the student may provide documentation (See
Guidelines for Adjudication). The student must be advised of his or her right to be accompanied
by an advisor (who may be an attorney, but may not participate in the hearings except as an
advisor to the student). All committee hearings shall be confidential.
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V. Guidelines for Adjudication by Faculty Review Committee
Upon the creation of the committee and the selection of a chairperson, the committee shall set a date and
time for a hearing. The date and time shall be in consideration of the schedules of the student and the
faculty members.
At the hearing, the student and complainant (the faculty member who brought the charges) shall present
evidence to the committee. Evidence may include, but is not limited to, course syllabi, assignment sheets,
and witness testimony. After the presentation of evidence, the committee may question the interested
parties. At the conclusion of the hearing, the student and complainant (and any witnesses) shall be
excused, and the committee shall review the evidence. Once a decision has been reached, the committee
will summarize its finding and provide a written recommendation to the Vice President of Teaching,
Learning and Student Development within three days of the hearing. The Vice President may accept or
modify the Advisory Committee’s recommendations and may determine additional sanctions or responses,
as necessary.
VI. Sanctions
A. Instructor Initiated Sanctions
1. Warning
2. Rewrite/Redo assignment
3. Failure on assignment or failure in course
4. Participation in non-credit Writing with Integrity tutorial
B. Administrative Sanctions
1. Disciplinary warning or probation
2. Participation in non-credit Writing with Integrity tutorial
3. Suspension
4. Expulsion
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As a student in the CLT program, you will be expected to behave as a professional. It is easy to
recognize a professional because they are good at what they do and they like doing it. They enjoy
helping others and knowing that they have made a difference. They treat everyone with dignity
and respect. Professionals set high standards for themselves and work hard to achieve them. They
care about quality and how to improve it. They continually strive to learn and grow in their
personal and professional lives. Professionals are recognized for their integrity. They are reliable,
accountable, and always team players.
Students who wish to make copies of printed materials while on campus should purchase a copy
card from one of the card dispensers. A copier is available for student use in the A building.
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Students are responsible for maintaining appropriate standards of conduct as described in this
student handbook and the Student Code of Conduct/Discipline procedure found in the ECC
college catalog. Students are expected to observe Clinical Laboratory Assistant program
regulations and meet professional standards as outlined in the Health Professions code of ethics.
A written warning will be issued for infractions of program regulations or professional standards.
A copy of the written warning will be kept on file in the Dean of Health Professions office.
Students who continue to violate program regulations or professional standards in which they
have previously been given a written warning will be permanently dismissed from the Clinical
Lab Assistant program.
When behavioral/affective reasons warrant an immediate action, a student may be dismissed
from the Clinical Lab Assistant program without a written warning.
Students who have been permanently dismissed from the Clinical Lab Assistant program are
permanently dismissed from the Health Professions division at ECC.
Causes for dismissal include, but are not limited to:
1. Unprofessional or dishonest behavior
2. Actions which jeopardize patient safety
3. Infractions of clinical facility policy
Dismissal Procedure
1. Program officials will review all facts and documentation related to the student’s
violation of program regulations or professional standards.
2. If warranted, the program official will prepare a Notice of Permanent Dismissal that
outlines the specific reasons for the dismissal.
3. The program official will meet with the student to present the Notice of Permanent
Dismissal. A student who is dismissed from the Clinical Lab Assistant program will not
be permitted to attend any further Clinical Lab classes/clinical and will receive failing
grades in the Clinical Lab courses in which they are enrolled.
Due Process / Student Appeal
Students have the right to file a complaint regarding issues that they feel require a resolution.
Students should follow the appropriate Student Appeal/Complaint procedure or Grade Appeal
procedure as outlined in the ECC college catalog.
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Students who complete CLT 101, CLT 105, CLT 106, and CLT 120 are eligible to receive a
Clinical Laboratory Assistant basic vocational specialist certificate from the college. Students are
encouraged to participate in the ECC sponsored graduation ceremonies which are held each year
in May and December. Students must apply for graduation in order to have the BVS certificate
posted on their transcript.
In exchange for the educational opportunities provided to me by the clinical rotations, I agree to
comply with all state, local, and federal requirements governing the privacy of medical
information. Those privacy requirements have been explained to me, and I have had training in
complying with these requirements. I agree to uphold all HIPPA and other privacy requirements
during my clinical rotations.
I understand that I am bound to comply with all privacy requirements when I am not at the
clinical rotation, including in my conversations with family, friends, and peers. I will be held
accountable for maintaining the privacy of any information I obtain, see, or am given during my
clinical rotations. To uphold the privacy of such information, I agree to not post or discuss any
clinical experience or information regarding my experience with the clinical agency, its staff, or
its clients/patients on any internet social media (Facebook, Twitter, emails, MySpace, Linkedin,
and any others not mentioned). I understand that administration periodically searches the internet
for breaches of its privacy policies. I will be prohibited from returning to the clinical site if I
violate any privacy requirement in any regard. Such violation may also result in a delay in
completing my degree requirements or in further disciplinary action against me by Elgin
Community College.
Contract of Handheld Technology
PDA/Smartphones/Handheld Computers – No electronics are allowed during any exams.
Students may not be able to see/hear/feel these devices during exams. If faculty allow a calculator
in an exam, the calculator will be provided by the school/instructor. Students with special
accommodations requiring a special device must have documented departmental approval in the
program director’s office before the beginning of the second week of class.
Audience Response System, ie: Clickers/Desire2Learn (D2L) – is where an audience response
system(ARS). You will be allowed to use your web enabled phone/computer/PDA for this
purpose. Please note that all informaiton you transmit is subject to editing by the instructor.
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Students must realize that any data transmitted via ARS may be seen by other students. It is
expected that all information shared will adhere to the schol’s code of conduct and the highest
professional principles. Some ARS activities will be graded. These graded assignments are
subject to the academic honesty policies applicable to exams and written work. False
representation or other forms of cheating will be considered academic misconduct and will be
referred to the Dean’s office. This policy applies regardless of whether a student is physically
present or in distance education.
PDA/Smartphones/Handheld Computers – Students using Handheld Devices (HHD) in clinical
will always follow these guidelines:
• The device will be in ariplane mode at all times while being used in the clinical
• The camera will not be accessed at anytime while in the clincal agency or a
clients’ home
• No pictures will be taken of any person, equipment, or location that is related to
clinical without prior written consent of the supervisor of that location, the
director of the program, and the faculty member.
• No texting, email, or communication of any type will ever be done in front of a
client or clinical agency staff member. At other times, the student must have
express permission of the clinical agency and their faculty member.
• Students agree that they will sanitize their HHD with an antibacterial wipe in
accordance with basic universal precaution standard (after all patient interactions
and at any time one would sanitize their hands/stethoscope).
Use of portable electronic devices in clinical is regulated by the clinical agencies, local, state, and
federal regulations and laws. Students are fully responsible to ensure that they adhere to all
regulations at all times whether at school, at clinical, on break, or any other time. This includes
proper management of confidential client information. All students are fully responsible for
following all regualtion of the HIPAA guidelines.
If there are any questions/concerns about whether or not certain data can be shared, stored, or
transmitted students agree to refrain until clarification can be made. It is important to err on the
side of caution. Any electronic device used for the purposes of transmitting educational material
that is related to clinical or client interactions must be secured with a password when not in use.
This includes computers, phones, PDAs and any other such device. Any communication about a
clinical or client related concept or event must be de-identified before transmission per HIPAA
Permission granted by Lewis & Clark Community College 8-2011
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Elgin Community College’s Clinical Lab Assistant Student Handbook provides information
regarding the policies and procedures in effect for the Clinical Lab Assistant program. Students
will be fully informed of any changes to this document.
Students must indicate agreement with each of the following statements by initialing on the lines
_____ I have received a copy of the [insert program name] student handbook.
_____ I am aware that it is my responsibility to ask questions about the contents of the [insert
program name] student handbook and have those questions answered to my satisfaction.
_____ I understand that failure to follow any of the policies in the Clinical Lab Assistant student
handbook may result in my dismissal from the Clinical Lab Assistant program.
_____ I agree to fully participate in the lab portion of the Clinical Lab assistant program. I
understand that this requires hands on participation and that parts of my body will be exposed
and touched.
_____ I agree that while enrolled in the Clinical Lab Assistant I will treat my studies, campus
labs, and clinical experiences as an employee would treat job responsibilities, recognizing that
my instructor assumes the role of my supervisor. I will attempt to learn the technical skills
required of a Clinical Lab Assistant, but also strive to develop professional behaviors and
Student (signature)
Student (print name)
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I give permission to release information regarding my professional qualities, academic
achievement, and clinical performance to the Clinical Lab Assistant Program Director when
responding to requests for employment consideration. This release does not include any
information submitted by me or at my direction relating to medical records or reasonable
accommodations under the Americans with Disabilities Act. This policy is revocable upon my
written request to the Clinical Lab Assistant Program Director.
Student (signature)
Student (print name)
I give permission to release photographs taken for the sole purpose of identification of my status
as a student enrolled in ECC’s Clinical Lab Assistant program to the affiliated clinical facilities
where I will be assigned.
Student (signature)
Student (print name)
I give permission to survey my future employer as part of the Clinical Lab Assistant program’s
assessment process. I understand that this information will be kept confidential and will be used
solely for the purpose of evaluating the effectiveness of the program meeting its goals.
Student (signature)
Student (print name)
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